Editor: Jody Schipper, MSN, RN
Professional Development Coordinator
Deadline for article submission is the 5th of each month
Class Reminder Emails from Net Learning
Have you added your email address to your Net Learning profile yet?
Make sure to do this so you can start receiving email reminders for your registered classes. Click here for instructions on how to add your email address to your Net Learning profile.
Once you have entered your email address, you should start to receive emails from Net Learning for classes in which you are registered. Note: This only applies to the face-to-face or classroom setting, not to CBLs.
You will receive two emails. The initial confirmation email will come within 24 hours of your registration. This will contain an attachment that can be added as an appointment to your Outlook calendar. The second email will arrive 3 days prior to the scheduled class date. This is a reminder notice and does not contain a calendar attachment.
To add the Outlook appointment to your calendar:
- Open the confirmation email
- Double click on the attachment
- Select “open”
- Click “save” from the toolbar at the top of the page
- Click “close”
- Check your calendar to make sure the appointment was successfully added.
Note: If you unenroll from a class in Net Learning, you must manually remove the appointment from your calendar. Net Learning does not send a cancellation notice to your calendar.
Congratulations to Tracy Elliott, RN, 3 Medical, for earning her MSN from Allen College in August.
If you, or someone you know, have earned an advanced degree, we want to hear from you. Please email Jody Schipper at firstname.lastname@example.org
Welcome New Nurses
Front row L to R: Katrina Turnis, Resource; Nicole Vance, 3 Medical; Roxane Cordes, 3 Medical; Kaleena Bettmeng, OR
Back row L to R: Diane Edgar, 3 Heart; Allie Aloisi, 4 Tower; Andrea Ohrt, OR; Lindsay Smith, OR; Sarah Tully, 3 Medical
From L to R: Trista Westpfahl, 3 Surgical, and Nicole Reicks, 3 Heart
8/17 Nonviolent Crisis Intervention
8/17 Preceptor Development
8/18 BLS Renewal
8/24 Diagnosing Acute Stroke and TIA: The Neurologist’s Work-up
8/25 Diagnosing Acute Stroke and TIA: The Neurologist’s Work-up
9/2 Nonviolent Crisis Intervention
9/7 Identifying Cardiac Dysrhythmias
9/7 Acute Stroke Management
9/8 Acute Stroke Management
9/8 Care of the Cardiac Surgery Patient for Critical Care Nurses
9/8 BLS Renewal
9/13 Respiratory Fit Testing
9/19 BLS Renewal
9/19 Ins and Outs of Chest Tubes
9/20 Understanding 12 Lead EKGs: Ischemia, Infarct, and Necrosis
9/23 Nonviolent Crisis Intervention – Refresher
9/28 Understanding 12 Lead EKGs: Axis Deviation, Blocks, and Conduction Defects
Paula Geise, RN, MSN,
Director of Cardiac/Intensive Care Services
The Directors, along with staff, have discussed transporting of patients with the Transporting department. At this time we will be transporting as many patients by cart and wheel chair as possible. Please be aware of this change so when transport comes to get a patient you understand why they will be transporting by wheel chair and cart and not in the beds. We want to eliminate as many bed transports as possible understanding that there will be certain circumstances that will require that. (A patient that codes and needs transported to ICU etc.) The background is that many of the hospital beds are being damaged during transports.
Beds are not meant for long transports and for going in and out of doorways. The low beds also cause problems as they do not move well and are not meant for transporting patients. The side rails and wheels are being damaged, causing expensive repairs. Recently one of the wheels fell off during transport and caused damage to the floor. The beds also do not have 02 tank holders. The 02 tanks need to be in holders and cannot just lay at the end of the beds. The cost of putting holders on all of the beds is very expensive. We will order some of the clip on holders that transport can use when a bed is needed for transport.
Please work as a team to move patients when necessary so that we do this safely. Many hands make light work.
This is a great example of how a team was able to fix a process together without adding to unnecessary costs.
Minors Staying with Patients
Please remember that it is not okay for a child to be left with a hospitalized patient without another adult to supervise the child. Minor children cannot spend the night with a hospitalized adult. The patient cannot appropriately care for the child while hospitalized and this responsibility then falls to the staff.
Click here to see SOP I-V-20-1 Visitor Regulations and Traffic Control for more information.
Preparing Vials for Injectable Medications
Chris Clayton, PharmD, MBA, Director of Pharmacy/Patient Safety Officer
A pharmacist observed a nurse preparing a medication that was to be given IV push and noticed the nurse did not use an alcohol pad to swab the vial stopper before entering the vial. When the pharmacist asked about this the nurse commented she had never been taught to swab the vial and she thought the cap on the vial provided a sterile environment for the stopper. After looking into this further it was determined that this could be a common issue and not one nurse in one area, so I wanted to send out some communication to raise awareness.
The cap on the sterile medication vial is typically a dust cover only and does not create a sterile environment for the stopper. After removal of the dust cap, the stopper should be swabbed with an alcohol pad by rubbing straight over the top pressing down on the stopper and the alcohol should be allowed to dry without blowing or waiving your hand over it prior to drawing up any medication.
The hospital nursing procedure reference “Clinical Nursing Skills and Techniques” 7th Edition by Perry and Potter does speak to this procedure on page 583 Step 5a.
Ampules should also be swabbed prior to breaking the top off. Why? A piece of glass could fall into the sterile solution upon breaking the top so swabbing the neck of the ampule prior to breaking the top would reduce the likelihood of a contamination falling into the solution. This is also why a filter needle should always be used for ampules.
If anyone has any questions please let me know.
Make sure to attend one of the upcoming stroke education classes. Click on links below for more information.
Diagnosing Acute Stroke and TIA
Acute Stroke Management
Linsey Schuldt, PharmD
New from the FDA: The FDA is recommending limiting the use of simvastatin 80mg because of increased risk of muscle damage. Simvastatin 80mg should be used only in patients who have been taking this dose for 12 months or more without evidence of myopathy. This dose should not be started in new patients, including patients already taking lower doses of the drug. Labeling changes also include maximum doses when used with interacting medications; most notable is a maximum dose of simvastatin 10mg when given with amiodarone, verapamil, and diltiazem.
A maximum simvastatin dose of 20mg is recommended when given with amlodipine and ranolazine. Gemfibrozil is now contraindicated with simvastatin. Changes to AMH’s current substitution policy were made to avoid substituting to the 80mg dose. Atorvastatin (Lipitor) is now on formulary. Orders for atorvastatin will be filled as written and will now be used to substitute orders for rosuvastatin (Crestor). Pharmacy will be developing a procedure for informing the physician of potential interactions or unsafe doses when ordered.
New medication on formulary: Arformoterol (Brovana®) Arformoterol is a nebulized selective long-acting beta-2-adrenergic receptor agonist (think of it like a long-acting albuterol), acting on bronchial smooth muscle resulting in relaxation of smooth muscle fibers and bronchodilation. Arformoterol is indicated for the long-term, maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema. Arformoterol was the first nebulized, long-acting beta-agonist and offers an alternative for COPD patients in whom a nebulized therapy is preferred to a dry powder inhaler (like Serevent or Foradil). There are no other apparent advantages over the hand held inhaler product. The recommended dose is 15mcg administered twice daily by nebulization.
Post-Procedure Monitoring Flowsheet and
Nursing Bedside Swallow Screen
Teresa Gavin, RN, MS, CCRN, Clinical Nurse Specialist, Critical Care
The Post-Procedure Monitoring Flowsheet has been revised based on feedback from staff. When it was decided to extend use of the MEWS to 48 hours, 2 forms were needed. We have added a second vital signs page.
Also, added to this flowsheet is a new form called the Nursing Bedside Swallow Screen. This form has been created as an intervention to help reduce the incidence of aspiration and hospital-acquired pneumonia. The form should be completed:
- On admission if on the Speech Therapy Section of the Functional Screen any of the boxes are checked yes. (You will note at the bottom of that CareCast screen it says: “If YES complete the Nursing Bedside Swallow Screen.”) The forms will soon be available in the admission packets.
- For all patients with acute or past stroke.
- If there is a suspected risk of aspiration.
- Post-extubation (including post-surgical patients).
- Post bronchoscopy, endoscopy, TEE, or any other procedure where the gag reflex could have been altered.
In addition to being attached to the Post-Procedure Monitoring Flowsheet, it is also available separately on the intranet.
The form is clear and walks you through what you need to do to properly assess a patient’s risk for aspiration/aspiration pneumonia.
To view the forms you can click on the links below.
Please contact Jeanette Westendorf for questions regarding the Nursing Bedside Swallowing Screen or Teresa Gavin for questions regarding the Post-Procedure Monitoring Flowsheet.
Watch for more education in the near future on prevention of
hospital-acquired pneumonia and use of this tool.
NURSING BEDSIDE SWALLOW SCREEN (New 7/12/11) #50230C278
POST-PROCEDURE MONITORING FLOWSHEET (Rev. 7/12/11) #50230C259
Isolation Precautions Update
Michelle Heine, Infection Control Manager
New isolation boxes and precautions signage will be rolling out hospital wide over the next month. This is after a trial was performed on 4 Tower and 3 Surgical. Thank you to the staff on those floors for their flexibility, recommendations and feedback.
These changes are being implemented to streamline workflow, ensure the appropriate PPE is easily accessible to staff and visitors and to improve communication regarding precautions and expectations to all those that enter the patient room.
The hospital wide rollout includes the use of new Isolation boxes that will be mounted directly on the patient room doors and the use of new signage. The signage is larger, easier to read and includes a series of pictures showing how to put on the required PPE before entering the room. The hope is that that the placement of the boxes and signs will help clarify expectations to family and visitors.
With the implementation of these new isolation boxes is a new process on initiating isolation. When it has been determined that a patient needs to go into isolation, Distribution is to be called and isolation initiation documented. Distribution will deliver and hang the isolation box on the patient’s door with its respective signage. Each isolation box is stocked with only the appropriate PPE that the precautions require. When you call Distribution to ‘order’ the isolation box, make sure to mention what type of isolation is needed. Please note: There are two new precautions signs- Contact/Protective and GI/Protective. This should cut down on the number of multiple signs hanging on one box.
Please remember, isolation must be initiated within 1 hour of when it has been determined a patient needs to be isolated. When there are ‘fallouts’, we are confident this is being done, however not documented in a timely manner. Please remember to document this! The Infection Control department is expected to audit charts for compliance with this 60 minute policy. Most floors are now using a stamper to document the initiation of isolation in the chart. If you are unfamiliar with this stamper, please speak with your Nurse Manager.
Krystle Primus, RN, BSN, BA,
Krystle enjoys swimming and playing outside with her 2 year old son. She is expecting her second child at the end of August.
Leslie Michael, RN, BSN, CN4,
Leslie enjoys spending time with her kids, swimming, cooking, and exercising.
|Emily Johnson, RN, BSN,
Emily likes to spend time with friends and loved ones.
||Tina Auge, RN, BSN,
Tina loves music, enjoys playing the piano, reading, and being outdoors.
Successful Joint Commission Survey
Jody Schipper, MSN, RN, Professional Development Coordinator
Allen Hospital was visited by Joint Commission the week of July 18-22, 2011. The group included two nurses (one for the hospital and one for the ambulatory/clinic setting), a physician, an engineer, and a lab surveyor.
The visit was a huge success! Steve Slessor, VP of Operations, reports the surveyors were very complimentary of the staff and the work being done here at Allen. Tami Jones, Clinical Director of Emergency Services and Nursing Operations, notes that there were no deficiencies found in the nursing department! Great job!
Several nurses were interviewed or observed by the surveyors. Here are a few of their stories…
Krystle Primus from Cardiac Rehab spoke with a surveyor about their processes. “He asked us about our fridge checks, code cart, emergency response, admission process, and assessments. We also talked about how we address fall risk and monitor pain. It was a little intimidating, but he was very friendly.”
ED nurse, Leslie Michael, spent over 30 minutes with a surveyor. He followed several patients throughout their ED stay. He also asked specific questions about various protocols, including the chest pain protocol, and how patient acuity is determined. Leslie felt the visit went well. “He was very straight forward and polite” she said.
3 Medical nurses Tina Auge and Emily Johnson both spent time with a surveyor. Emily was accompanied during a medication administration that included hanging IV antibiotics. He asked several questions about the process, specifically what checks are in place to ensure the right dose and drug are given to the right patient. “This was easy for us because we have barcoding in place. Barcoding helps prevent those types of errors” says Emily.
Tina Auge was interviewed by a surveyor during his review of several patient records. He started by asking about the admission process and CareCast documentation. “He was very focused on how we ensure the patient’s environment is safe” Tina said. He then asked what they do with the information gained during the admission assessment, and how that information is incorporated into the plan of care. “He was impressed by our Care Graph progression” says Tina. She continues “We always try to be on our A-game, but of course we can always improve. We continually strive to be better.”
There were several other nurses who were interviewed by surveyors and we want to acknowledge their great work as well. Special thanks to Chris Clarkson, ICU; Debbie Hannan, ICU; Theresa Hippen, ICU; Alicia Mason, 3 Heart; Darlene Joss, 3 Heart; Donna Duncan, Cath Lab; Juli Schroeder, Cath Lab; Deb Schilling, 3 Medical; Val Hileman, 4 Tower; Amanda Wagner, OB; and all others for a job well done.
Tina sums it up best saying “Allen is a wonderful place to work. Everyone works together and the patients feel that. I am proud that Allen is a great place to be for our patients. They are receiving the best care possible and I am excited to be part of that!”
Way to go Allen Nurses! You have a lot to be proud of!